Patterns of failure among patients with squamous cell carcinoma of the head and neck who obtain a complete response to chemoradiotherapy

Yovino, Susannah; Settle, Kathleen; Taylor, Rodney J.; Wolf, Jeffrey S.; Kwok, Young; Cullen, Kevin J.; Ord, Robert A.; Zimrin, Ann B.; Strome, Scott E.; Suntharalingam, Mohan

doi:10.1002/hed.21141

Cited by 15 publications

(17 citation statements)

References 17 publications

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“…Those with residual neck disease after treatment (groups 1 and 2) demonstrate survival similar to or even increased to those with initial complete response (group 4) regardless of N stage. This is different than Yovino et al's data that supports decreased survival in partial responders irrespective if they subsequently received a neck dissection or the pathology of the neck dissection 10. However, Argiris et al's11 retrospective review of three large trials show that neck dissection can convey a survival benefit in the N3 incomplete responders, and complete responders did not show improved survival with a planned neck dissection.…”

Section: Discussionmentioning

confidence: 81%

Treatment outcome in the residually positive neck after definitive chemotherapy and irradiation

et al. 2011

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Section: Discussionmentioning

confidence: 81%

Treatment outcome in the residually positive neck after definitive chemotherapy and irradiation

et al. 2011

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“…This group represents a rare, but encountered, patient population where the utility of salvage ECL is not well defined. [9][10][11] Our current study shows a relatively high rate of occult cervical metastases in the ECL group, with 40% (4 out of 10) of this group having at least 1 metastatic node (and 33.3% [4/12] of neck sides having at least 1 metastatic node, when each neck side is considered individually). If the 6 neck sides in the observation group (that were preradiation N1 and showed no evidence of regional recurrence for the near 2-year follow-up in this study) are considered to be without occult metastasis, then the overall rate of occult metastasis in this study is 22.2% (4 out of 18).…”

Section: Discussionmentioning

confidence: 88%

Elective Lymphadenectomy during Salvage for Locally Recurrent Head and Neck Squamous Cell Carcinoma after Radiation

Prendes

Aubin-Pouliot

Egbert

et al. 2014

Otolaryngol.--head neck surg.

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“…For primary tumors in the oral cavity, locoregional recurrence can occur within the cavity, the cervical nodes, or along the paths of the 5th, 9th, and 12th cranial nerves. 12 When a patient with squamous-cell carcinoma of the head and neck has pain in the head and neck region, recurrent disease is always a concern, since this type of cancer can be neurotropic, as it was in this case. When squamous-cell carcinoma of the head and neck involves the 5th cranial nerve, typical findings are pain or numbness in the distribution of the affected branches.…”

Section: Recurrent Squamous-cell Carcinomamentioning

confidence: 88%

Case 29-2012

Wirth¹,

Plotkin²,

Emerick³

et al. 2012

N Engl J Med

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Pr e sen tat ion of C a seDr. Mikael L. Rinne: A 49-year-old man was admitted to this hospital because of fever, pain, and cranial-nerve deficits after treatment of squamous-cell cancer of the oral cavity.Approximately 9 months before admission, a painful ulcer developed on the right side of the floor of the mouth. Imaging studies performed at another institution revealed an enhancing lesion in the floor of the mouth; a biopsy specimen of the lesion revealed poorly differentiated squamous-cell carcinoma. The patient had a history of depression and alcoholism and had spent time in halfway houses; he had stopped drinking alcohol 3 months earlier. He had smoked cigarettes (70 pack-years) but had stopped smoking after the diagnosis of oral cancer; he did not use illicit drugs. Four months before admission, right hemiglossectomy, resection of the right side of the floor of the mouth, bilateral modified radical neck dissection, and reconstruction were performed at the Massachusetts Eye and Ear Infirmary. Pathological examination of the tissue revealed a large (stage T4), invasive, poorly differentiated squamous-cell carcinoma, with extensive lymphovascular and focal perineural invasion, bilateral lymph-node metastases (stage N2c), and positive margins. After surgery, dental extractions were performed in anticipation of radiation, and a submental abscess developed, which resolved after antibiotic therapy and incision and drainage. Radiation therapy (66 Gy, over a period of 6 weeks) and concurrent chemotherapy (paclitaxel and carboplatin) were administered. Throughout the treatment, the patient reported severe pain in the radiation field that required narcotic analgesia.Four days after the completion of radiotherapy, pain developed around the right eye and forehead, with ptosis and diplopia, and the temperature rose to 38.3°C. The patient was admitted to another hospital. Cultures of the blood and urine were sterile. Computed tomography (CT) of the head and neck reportedly showed posttreatment changes but no fluid collection within the surgical bed or the neck. During the next 4 days, pain worsened and complete right ophthalmoplegia developed. InThe New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF VIRGINIA on October 7, 2012. For personal use only. No other uses without permission.

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Patterns of failure among patients with squamous cell carcinoma of the head and neck who obtain a complete response to chemoradiotherapy

Abstract: We recommend observation after definitive chemoradiation for complete responders. Further research is needed to improve outcomes among partial responders.

Cited by 15 publications

References 17 publications

Treatment outcome in the residually positive neck after definitive chemotherapy and irradiation

Treatment outcome in the residually positive neck after definitive chemotherapy and irradiation

Elective Lymphadenectomy during Salvage for Locally Recurrent Head and Neck Squamous Cell Carcinoma after Radiation

Case 29-2012

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